Effect of Low-Density Lipoprotein Apheresis on Restenosis after Coronary Angioplasty

本研究采用前瞻性研究方法，观察经皮冠状动脉腔内成形术（PTCA）前后即刻行低密度脂蛋白（LDL）血浆分离术对预防PTCA后冠状动脉再狭窄的有效性，并观察脂蛋白（a）[Lp（a）]和凝血纤溶因子对PTCA后3个月再狭窄的影响。在LDL单采前后采集血样。11例患者在PTCA前一天和术后2天接受了LDL单采术。对照组6例患者行PTCA但未行LDL单采术。血浆脂蛋白（a）水平由单采前的576.4 × 80.1mg/L降至单采后的172.7 × 80.1mg/L，血清纤维蛋白肽A（FPA）和凝血酶-抗凝血酶Ⅲ复合物（达特）由单采前的10.7 × 19.5ng/ml降至2.0 × 2.2ng/ml，由单采前的13.0 × 22.4ng/ml降至5.3 × 6.7ng/ml。而血浆组织纤溶酶原激活物/抑制物复合物（PAPA 1复合物）、α 2纤溶酶抑制剂纤溶酶复合物（PPI复合物）和D-D二聚体在血浆分离后均无明显升高。血浆低密度脂蛋白分离组冠状动脉病变再狭窄率（26.7%）明显低于对照组（41.7%）。这些结果表明，低密度脂蛋白血浆分离术是有效的预防冠状动脉病变的再狭窄的高血浆Lp（a）的患者，因为降低凝血活性。

A prospective study was performed to determine whether low-density lipoprotein(LDL) apheresis, then performed only immediately before and after percutaneous transluminalcoronary angioplasty(PTCA), is effective in preventing restenosis of coronary artery lesions following PTCA.Furthermore to determine the influence of between lipoprotqin(a) [Lp(a)] and coagulation-fibrinolysis factors to restenosis 3 months after PTCA, blood samples were taken before and after LDL apheresis. The previous day and 2 days after PTCA, 11 patients underwent LDL apheresis. 6 patients of the control group underwent PTCA but did not underwent LDL apheresis. Lp(a) levels were reduced from 576.4* 80.1 mg/L before apheresis to 172.7*80.1 mg/L after apheresis.Serum fibrinopeptide A(FPA) and thrombin antithrombin III complex(TAT) were reduced from 10.7*19.5 ng/ml to 2.0*2.2 ng/ml, from 13.0*22.4 ng/ml to 5.3*6.7ng/ml. But tissue-plasminogen activator/inhibitor complex (PAPAl complex), alpha 2 plasmin inhibitor plasmin complex (PPI complex) and D D dimer were not significantly high after apheresis. The rate of restenosis of coronary artery lesion was significantly lower in the LDL apheresis group (26.7%) than in the control group (41.7%). These findings suggest that LDL apheresis is effective in preventing restenosis of coronary artery lesions in patients with high plasma Lp(a) because reduction of coagulationactivity.